GW1--05961_Well Construction - GW1_20241009

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WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Ricky Corriher 114.WATER ZONES ' i ,I ,
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Well Contractor Name FROM I TO Dt:SCRIP'fION •
2464-A I 7,5-r`' /99 ft. Vii 51 ,
NC Well Contractor Certification Number (�'-�ft. T GV t Q
IS:OUTER CASIN"G'(for`miilti cases 2lls):ORLI IER'(if:ap licable):
Frank A. Corriher&Sons Well Drilling, Inc. FROM TO , DIAMETER THICKNESS MATERIAL
ft. ft. '. in.
Company Name
16:'INNER`CASIN,GORTUBLNG(geothermalclosed:loop) ,-
2.Well Construction Permit#: df r, O�/t•%i j i,J`ft./ FROM Ti) I DIAMETER THICKNESS MATERIAL
List all applicable•ne!l construction permits' `tiiC.Comic.State.l in-fiance.etc) 1 ft. 1 V,ry Ctt 6�18 ,in. SDR-21 eve o
3.Wel se(check well use): /a gft. •,l i d ft. /��in. / G� C ��
W. 'r Supply Well: 17.SCREEN- t0 a J
VK��- FROM 10 DIAMI(TERi st.oTSIZE .. .THICKNESS SIATERIAI.
gricultural OMunicipal/Public , - ft. ft. in.
a Geothermal(Heating,Cooling Supply) 0 Residential Water Supply(single)
ft. I ft. in.
Industrial/Commercial Residential Water Supply(shared) lg,GROUr. . I
Irrigation FROM TO MATERIAL• EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
I Monitoring [3 Recovery ft. 1 ft.
injection Well: - -
ft. ft.
Aquifer Recharge DGroundwater Remcdiation
alinit'Barrier
Aquifer Storage and RecoveryS 19:SAND1GRAYEL-PACK "-' .-_"-
O` FROM • TO MATERIAL EMPLACEMENT METHOD •
r Aquifer Test QStonnwatcr Drainage ' ft. ft.
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Experimental Technology 0 Subsidence Control ft. 1 ft. 1.
au Geothermal(Closed Loop) DTracer .20:"DRILLING;LOG(attach•additionalsheetsifnecessary)..__ -
DESCRIPTION teeter.hardness,suit/rock ty •
I FROM I TO DESCR c ._.
Geothermal(Heating/Cooling Return) Other(explain under?:21 Remarks) r. rain sir,etc.)
D ft. I J i1 I.
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4.Date Well(s)Completed: / 9'51 llr'ell ID# Iav, ft. a_e) ft. U` o
5a.Well Location:• _/ • (� ft' v'ft. S eb^' fyi0('✓(G
Dep./Vs S O�Prc.45J� fly ft. DS Wit: A I 'viGr J-€
Facilityn/OwnnccNamee Lt, i/e
F.a�c/iillity IDS=((ifapplicable) • ft. - ft.kd 0 i t(�Ql of/� ft. ft. I .-q� ->. ' :Tr:
i !'-:.;
ft. ft. • t 'S
Physical Address j.ity.and Zip • OCT
sL/ LP r / / Z1.:REMARIC •i,`.. r - -. C I. :0 2024..._. •
County Parcel identification No.(PIN) 1h
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: �i v`;t-.;'s;^^�L r t,.,e::_.s.:n
(if well field.one lavlong is sufficient) p /� 22.Cent' anon:
• 35. f/Q3 N 5° a 0.0 �o 7 ll. n �'. '
9..,25,--,1,2,
6.Is(are)the well(s) Permanent or Temporary Signature offer'tcd Well Contractor ' Date
Ur signing this torn,.l hereby certi(i,that McwcliIs)tear turret constructed in myth-dance7.Is this a repair to an existing well: �l'es or o ` with 1 is f NC?IC 02C.0100 or 15.4 NC.4C 02C.0200 Well Construction Standards and that a
if this is a repair.Jill out known well construction information and explain the nature of the /n'of this record has been provided tithe wel!'ntenen
repair under#2!remarks section or on the back of this form. '
23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
3.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
- construction.only I GW-I is needed, Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary. '
drilled: ��� �i
SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: (ft,) i
24a. For All Wells; Submit this fo:rni within 30 days of completion or well
For multiple wells list all depths if different(example-3(e_,200'and_'�!100'I
construction to the following:
10.Static water level below top of casing: . 5-0 (ft.) Division of Water Resources,lnibrmation Processing Unit, -
1/writer level is above'casing;use' 1617 Mail Service Cen'eri Raleigh,NC 27699-1617
11.Borehole diameter: ' CO (in.)
24b.For Injection Wells: In addition to sending the form to the address in 24a
Air Drill above, also submit one copy of this f ml within 30 days of completion of well •
12.Well construction method: construction to the following:
i i.e.auger.rotary,cable,direct push.etc.) - - I,
Division of Water Resources.Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center.Raleigh.NC 27699-1636
13a.Yield(gpm) Method of test: Air 24c. For Water Supply& Injection Wells: in addition to sending the form to '
the address(es) above, also submit onci copy of this form within 30 days of- '
Sterilene • -
13b.Disinfection type: amount: C��S completion of well construction to the county health department of the county •
where constructed. I
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Form OW-I North Carolina Department of Ernironmenta)Quality-Division of Water Resources i Revised 2-22-2016 -- =,-.*'
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